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physiology Flashcards

1
Q

when can breast milk start being produced

A

3rd month

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2
Q

what are the systemic effects of oestrogen

A

metabolism of protein/ carbs/ lipids
water and electrolyte balance
blood clotting

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3
Q

what is induction of labour

A

attempt made to artificially start labour
amniotomy - artificial rupture of membranes
synthetic IV oxytocin for contractions

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4
Q

name 4 physiological changes that prepare the body for the expulsion of the foetus

A

cervix softens
myometrium tone changes
progesterone decreases
oxytocin is produced

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5
Q

what occurs in the passive 2nd stage of labour

A

full dilation of cervix before involuntary expulsive contractions

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6
Q

describe the mechanism of labour

A

1) descent - down pelvic cavity
2) flexion increase
3) internal rotation of head (45 degree) when hits pelvic floor
4) crowning and extension of head (widest part through)
5) restitution - line head back with shoulders
6) internal rotation of shoulders - fit through pelvic outlet
7) external rotation of head (45) in line with shoulders
8) lateral flexion - guide shoulders out

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7
Q

what is a big risk in an induced pregnancy

A

uterine hyperstimulation - by prostaglandins/ oxytocin

fetal monitoring required

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8
Q

what is the fetal attitude a measure of

A

how flexed the head is

ideal - chin on chest, suboccipitobregmatic 9.5cm

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9
Q

how do you measure fetal well being in a low or high risk baby

A

low - intermittent auscultations of fetal heartbeat (doppler)
high - CTG

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10
Q

how long should the passive 2nd stage of labour last

A

1 hour

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11
Q

what 3 things can cause an inadequate progression in labour

A

power - contraction - uterine activity
passages - birth canal
passenger - baby - malposition .

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12
Q

what kidney marker increases with gestation that may be a marker of pre-eclampsia

A

urea

>600 = neonatal death

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13
Q

give examples of decidual changes that occur after ovulation

A

dilation of vessels to increase blood supply

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14
Q

what happens to arterial blood reaching the testis

A

mixed with venous blood in a plexus of veins to cool it down

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15
Q

what is the role of testosterone in the male reproductive system

A

maintain male sexual function

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16
Q

how would you tell if a baby was hypoxic during birth

A

fetal blood sampling from skull

acidic pH

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17
Q

what would you do if a pregnant mum past term had a low Bishops score (cervix not dilated/ effaced)

A

vaginal prostaglandin pessarie

cook balloon - dilate and open cervix

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18
Q

what drug can be used to encourage contractions in labour

A

oxytocin

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19
Q

when should women be seen by their GP after giving birth

A

6 weeks

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20
Q

what thyroid changes may occur in pregnancy

A

major iodine transfer to foetus may lead to deficiency

increased T3/4 requirements from liver metabolism

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21
Q

what occurs in the active 2nd stage of labour

A

presenting part is visible
expulsive contractions with a fully dilated cervix
active maternal effort

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22
Q

what methods are there of assisted/ instrumental delivery

A

forceps

vacuum extraction

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23
Q

what are the 2 phases of the 2nd stage of labour

A

passive

active

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24
Q

what its the ideal lie/ presentation/ attitude/ position

A

lie - longitudinal
presentation - cephalic
attitude - good flexion
position - LOA, ROA

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25
Q

when is mitotic division of oogoium complete

A

shortly after birth - 5 months

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26
Q

when should you be suspicious of a DVT/PE in a pregnant woman

A

unilateral leg swelling

SOB or chest pain

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27
Q

what does the physiological management of the 3rd stage of labour compromise of

A

no routine uterotonic drugs / clamping of cord

maternal effort delivers the placenta (once she feels heaviness in birth canal)

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28
Q

what is the role of oestrogen in the female reproductive system

A

supports secondary female characteristics
negative feedback control of LH, FSH and GnRH
stimulates proliferation of endometrium

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29
Q

list some of the targets of testosterone

A

cns (Aggressive behaviour)
striated muscle
prostate, seminal vesicles, testis, penis
hypothalamus/ anterior pituitary - negative feedback

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30
Q

what are oogonium

A

ovarian stem cells

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31
Q

which of CPR or ESR is used as a sign of inflammation/ infection in pregnancy

A

CRP - stays the same

ESR raised

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32
Q

what is the role of FSH in the female reproductive system

A

stimulates follicular recruitment and development

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33
Q

what factors may effect spermatogenesis

A 
testis temperature
loss of blood-testis barrier
immune reactions 
reduction on gonadotrophin and androgens
environmental toxins  - alcohol, smoking, radiation
drugs 
site - trauma, cancer, surgery
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34
Q

where are sperm matured

A

epipdydimis

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35
Q

how often are vaginal examinations done in the active process of labour

A

every 4 hours

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36
Q

describe the latent first stage of labour

A

a period during which there are intermittent, often irregular, painful contractions which bring about some cervical effacement and dilation up to 4cm

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37
Q

what components make up the bishops score

A 
dilation
length of cervix (effacement) - 3,2,1
position - posterior, mid, anterior 
consistency  - firm, medium, soft 
station
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38
Q

what days of the menstraul cycle does the pre-menstraul phase last

A

day 26-28

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39
Q

what is the anticipated progress rate of the established 1st stage of labour

A

0.5-1cm per hour

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40
Q

when does a spontaneous vaginal birth (SVB) normally occur

A

37-42 weeks gestation

foetus presenting by vertex

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41
Q

what % of births need assisted/ instrumental delivery

A

15%

20% of first births

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42
Q

what does the 2nd stage of labour last between

A

full cervical dilation - birth of baby

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43
Q

why does Alk phosphate increase so much in pregnancy

A

produced by the placenta

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44
Q

what hormone does the corpus lute secrete and why

A

progesterone - prepares womb for pregnancy

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45
Q

what is an amniotomy

A

artificial rupture of membranes - usually with sharp hook (amniohook)

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46
Q

what obstetric emergency is a baby with a transverse lie at risk of

A

cord prolapse - cord vasospasm and stops pulsating

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47
Q

name some indications for induced pregnancies

A 
diabetes - big babies
post dates - term + 7 days 
maternal health problem 
fetal reagans - growth concert, oligohydramnios
social request 
pelvic pain
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48
Q

what is the definition of a secondary post partum haemorrhage

A

blood loss >500ml from 24 hours post partum to 6 weeks

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49
Q

what is the rate of emergency caesarean section in the UK

A

25%

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50
Q

what would you do if a pregnant mum past term had a Bishops score >7 (cervix dilated/ effaced)

A

amniotomy

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51
Q

when is the established 1st stage of labour complete

A

10cm

8 hours primigravida, 5 hours multigravida

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52
Q

what is the role of GnRH in the female reproductive system

A

stimulates LH and FSH secretion from anterior pituitary

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53
Q

when does the cardiovascular system return to normal after giving birth

A

3 months
(volume decreases by 10% 3 days post delivery)
BP by 6 weeks , HR 2 weeks

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54
Q

is is negative or positive feedback of oestrogen that leads to the LH sure on day-14 of the menstraul cycle

A

positive

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55
Q

what is the role of GnRH in the male reproductive system

A

act on anterior pituitary to release LH and FSH

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56
Q

what is seminal fluid comprised of

A

5% bulbourethral gland
30% prostate galnd
60% seminal vesicle

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57
Q

where does oedema most affect in pregnancy

A

fingers
lower limbs
(less able to excrete Na and H20)

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58
Q

what things may cause a secondary post partum haemorrhage

A

retained tissue
endometritis (infection)
tears/ trauma

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59
Q

why is glucose in urine common during pregnancy (glycosuria)

A

state of insulin resistance

placenta produces a hormone that is anti-insulin

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60
Q

what hormone on day 21 of the menstraul cycle is a reliable sign of ovulation

A

progesterone

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61
Q

what score is used clinically to assess the cervix for induction of labour

A

Bishop’s score

higher the score , more likely induction to be successful

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62
Q

what is the role of testosterone in the penis

A

erective, copulatory and ejactulatory effectiveness

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63
Q

what is the increase of blood flow to the kidneys in pregnancy

A

60-80% by end of 2nd trimester

microscopic haematuria may be present

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64
Q

how much does GFR/ creatinine clearance increase in pregnancy

A

50%

also increased protein excretion

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65
Q

list situations not to labour

A 
obstruction to the birth canal 
malpresentation - transverse
medical condition not safe for mum - cardiac, aortic stenosis, retinal detachment 
specific previous labour complications
fetal conditions
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66
Q

give functions of sertori cells

A

blood-testis barrier
isolate from immune system
physical movement of developing sperm towards lumen
give nutrients to sperm - encourage development
removal of waste (phagocytosis)
removal of excess cytoplasm following cell divisions

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67
Q

what is the corpus luteum

A

what is left from the follicle that released the egg

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68
Q

list some breast changes in pregnancy

A

increased size & vascularity (warm, tense, tender)
increased pigmentation of areola and nipple
secondary areola appears
montgomery tubercules on areola
breast milk form 3rd month

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69
Q

what happens to the platelet count in pregnancy

A

decreases - due to dilution as plasma volume increases

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70
Q

what values determine a sub -optimal rate of progression of active labour in primigravid and porous women

A

primigravida - <0.5cm per hour (2cm in 4 hours)

porous - <1cm per cour (4cm in 4 hours)

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71
Q

how long is a primigravida mother expected to be in the 2nd stage of labour for

A

3 hours

2 hr for multigravida

72
Q

why does a pregnant woman lying flat lead to a 25% reduction in CO

A

IVC compressed by uterus

73
Q

what days of the menstraul cycle does the secretory phase last

A

day 14-26

74
Q

what is the role of progesterone in the female reproductive system

A

maintain secretory endometrium

negative feedback control of HPO

75
Q

what is the body’s increase in oxygen demand whilst pregnant

A

20%

76
Q

which hormone rises dramatically in the luteal phase of the female menstraul cycle

A

LH surge

77
Q

which cells produce sperm

A

germ cells near basement membrane of seminiferous tubules, move into lumen as spermatogenesis takes place

78
Q

when is the 3rd stage of labour prolonged in active management and physiological management

A

active - 30 mins

physiological - 60 mins

79
Q

what dilation in cm does the latent 1st stage of labour change to the established stage

A

4cm

80
Q

what is the optimum temperature for sperm production

A

32 degrees

81
Q

what determines how many eggs you are born with

A

mothers health and lifestyle

genetic background

82
Q

what is the fetal station a measure of

A

babies head in relation to pelvis

83
Q

how may the foetus lie

A

longitudinal - vertex/ breach
oblique-
transverse

84
Q

list some things that may cause fetal distress

A 
infection - intrauterine distress
uterine hyperstimulation 
breathing problems 
insufficient placental blood flow 
multiple births 
cord compression/ prolapse
shoulder dystocia
85
Q

what is the normal expected weight gain during pregnancy

A

10-14 kg

2kg 1st triester, 5kg 2 &3

86
Q

what is the role of LH in the male reproductive system

A

targets androgen production of testosterone to maintain male sexual functions

87
Q

what drug can be given in labour to achieve adequate contractions

A

IV oxytocin

88
Q

how often is the intermittent foetal HR monitoring undertaken in the 1st and 2nd stage of labour

A

1st - every 15 mins
2nd - every 5 mins
(usually after every contraction)
same member of staff - continuity

89
Q

what happens to PCO2 and PO2 during pregnancy

A

PCO2 - decreases as breathing quicker
PO2 - increases - f
ully compensated respiratory alkalosis

90
Q

what 3 things do you use to evaluate the progress of labour

A

regular contractions
cervical effacement & dilation
descent of the fetal head through the maternal pelvis (station)

91
Q

what hormone co-ordinates the growth of one follicle in the follicular phase of the menstraul cycle

A

FSH

92
Q

what are the 4 hormones involved in the male reproductive system

A

GnRH
FSH , LH
testosterone

93
Q

what is the 1st and 2nd most common positions for a baby to be born in

A 
occipital anterior (facing floor)
occipital poster (facing roof)
OT/ OL transverse can't be born vagianlly
94
Q

what is the name of the final follicle produced in the follicular phase of the menstraul cycle

A

mature grafiaan follicle

95
Q

what is the main difference between primary and secondary spermatocytes

A

primary -46 chromosomes

secondary - 23 chromosomes

96
Q

how many eggs does a woman use in her lifetime

A

400

97
Q

what is released when a primary oocyte divides

A

secondary oocyte + polar body

released at ovulation under hormones

98
Q

what is the role of testosterone in the testis

A

spermatogenesis

99
Q

why does a physiological anaemia occur in pregnancy

A

50-70% increase in blood volume but only 40% increase in RBC

100
Q

what is meant by station (-3-3)

A

measurement of descent of the baby’s head
-3-0 - presenting part above ischial spines
0- aligned with ischial spines
0-3 - in the birth canal

101
Q

what does the active management of the 3rd stage of labour compromise of

A

routine uterotonic drugs
deferred clamping & cutting of cord
controlled cord traction after signs of separation form the placenta

102
Q

how many mitosis and meiosis processes occur in females to produce an egg

A

1 mitosis - oogonium > primary oocyte
meiosis 1 - primary oocyte > secondary oocyte + polar body
meiosis 2 - secondary oocyte > mature ovum + polar body

103
Q

what happens to the WCC in pregnancy

A

increase

baby is a foreign body

104
Q

What cardiovascular features increase during pregnancy

A 
circulating blood volume
increased blood flow 
increased CO (40%)
increased stroke volume
Increase heart rate 
O2 consumption
105
Q

do asthmatic ladies struggle in pregnancy

A

no - progesterone causes bronchodilation

labour produces indogenous steroids

106
Q

what is the leading cause of maternal death in the UK

A

maternal sepsis

107
Q

what is the definition of a primary post party haemorrhage

A

blood loss >500ml within 24 hours from delivery

108
Q

what is the average number of eggs at birth

A

2, 000, 000

109
Q

what cells release oestrogen

A

granulosa cells

110
Q

what happens to creatinine and urea levels in pregnancy

A

decrease - GFR increases so waste products are excreted quicker

111
Q

what cells to oogonium divide into

A

primary oocytes

112
Q

how much more times likely is thromboembolic disease is pregnancy/ post partum

A

6-10x

113
Q

list some of the targets of oestrogen

A 
cervix, uterus, fallopian tube
mammaroy gland 
fat distribution 
Bone - matures turnover
anterior pituitary, hypothalamus
114
Q

what cells form the blood-testis barrier

A

sertoli cells

no blood contact - capillaries provide O2

115
Q

why does the myometrium tone change to prepare for expulsion of the baby

A

allow for co-ordinated contractions

116
Q

how many sperm are there per ml of ejaculate

A

20-100 million

117
Q

how long are sperm matured for

A

3 months

118
Q

what are increased risks in caesarean sections compared to vaginal births

A 
infection 
bleeding
visceral injury 
VTE
(lower risk of perineal injury)
119
Q

how many semiferouh tubules make up the testis

A

300-900million

120
Q

what 5 hormones are involved in the female reproductive system

A

GnRH
FSH , LH - gonadotrophins
progesterone, oestrogen

121
Q

what is puerperal psychosis

A

rare but serious psychotic illness - need in patient care

more common in women with a personal/ family history of affective disorder, bipolar disorder or psychosis

122
Q

what should you assess the liquor for once the membranes have ruptured in pregnancy

A

colour
smell
volume

123
Q

on a cardiotocograhy (CTG) scan what would you expect to see during contractions

A

accelerations in heart rate

if decelerations/ flat lines = fetal distress

124
Q

what hormone makes the endometrium undergo decidual changes after ovulation

A

progesterone

125
Q

what 4Ts can cause a post partum haemorrhage

A

tone - pelvic
tissue - placenta
thrombin - clotting problems
trauma - tears

126
Q

how would you measure the foetal heart rate intermittently and continuously

A

intermittent - doppler, pinnards

continuous - CTG (cardiotograph)

127
Q

what does the cervix do to prepare for labour

A

softens

changes from firm and posterior with a supportive role to anterior / paper thin birth canal

128
Q

why do pregnant women get pink hands and feet

A

drop in total peripheral vascular resistance

129
Q

when does the secondary oocyte complete its 2nd meiotic division

A

when it is fertilised by the sperm to form mature ovum and 2nd polar body

130
Q

describe the established 1st stage of labour

A

regular, painful contractions that result in progressive effacement and cervical dilation from 4cm -10cm

131
Q

why does heartburn/ reflux commonly occur in pregnancy

A

hormones relaxed stomach sphincter

bump

132
Q

name 3 possible complications in the 3rd stage of labour

A

retained placenta
post partum haemorrhage
Tears

133
Q

what is cervical effacement

A

cervix becomes soft and thin

134
Q

what is the role of LH in the female reproductive system

A

maintain dominant follicle
induce follicular maturation and ovulation
stimulate corpus luteum until fertilisation takes place

135
Q

how do sperm travel form the epididymis to the urethra

A

vas deferens

136
Q

what is the role of FSH in the male reproductive system

A

stimulates sperm production

137
Q

what happens to FSH levels once the egg has been released

A

drop - follicle no longer needs to grow

138
Q

what 2 things help to keep the testis at 32 degrees

A
  • pampiniform plexus of veins mixing with arterial blood

- testes are outside the body

139
Q

what hormone causes the egg to be released in the female menstraul cycle

A

LH surge

140
Q

what days of the menstraul cycle does the menstraul phase last

A

day 1-4

141
Q

what should be taken in the 1st trimester to reduce the chances of neural tube defects

A

folate acid

142
Q

what is seen in cephalopelvic disproportion (CPD)

A

fetal head is in correct position for labour but is too large to negotiate the maternal pelvis and be born
quite rare

143
Q

how long does sperm production take and how long for transport to epididymis

A

production - 60-75 days
transport - 10-14 days
3 month cycle

144
Q

what drugs may affect spermatogenesis

A

anabolic steroids
anti-hypertensive
anti depressant

145
Q

how would you assess the engagement, station, cervical effacement and dilation during labour

A

vaginal examination

146
Q

what days of the menstraul cycle does the proliferative phase last

A

day 4-14

147
Q

what hormone thickens the lining of the womb whilst the follicle is growing

A

oestrogen

148
Q

how many fully formed sperm does 1 spermatogonium divide into

A

512

149
Q

what is the site of sperm production

A

seminiferous tubule

150
Q

where do the autocrine & paracrine signals that imitate labour come from

A

maternal, foetal, placental

151
Q

what 2 hormones are higher during the follicular phase of the menstraul cycle than they luteal phase

A

FSH, LH

152
Q

what happens to haemoglobin during pregnancy

A

decreases

RBC and volume increase > relative

153
Q

what percentage of women develop oedema in pregnancy

A

80%

154
Q

what percentage of pregnancies need induce

A

20% -1 in 5

155
Q

what cells produce testosterone

A

laidig cells surrounding testis

156
Q

what are the 2 phases of stage 1 of labour

A

latent 1st stage

extablished 1sts stage

157
Q

how much do a pregnant ladies iron and folate requirements increase in pregnancy

A

iron - 2-3x

folate - 10-20x

158
Q

how is pregnancy SOB the opposite of pathological

A

gets better with activity

159
Q

what type of feedback in the female hypothalamic-ovarian axis should be altered in IVF

A

negative feedback of oestrogen

increase fertility

160
Q

define labour

A

the process in which the foetus, placenta and membranes are expelled via the birth canal

161
Q

what if the biggest factor to affect fertility

A

age - rapidly declines after 35

162
Q

when is fatigue best and worst in pregnancy

A

bad early
best 2nd trimerster
worst in 3rd trimester

163
Q

what happens to the corpus lute if no pregnancy occurs

A

degenerates to corpus albicans

164
Q

how often should the contractions be in labour

A

3/4 : 10 minutes
lasting approx 40-60s
moderate to strong in strength

165
Q

what chemicals cause the increase in HR and BP during labour

A

catecholamines

166
Q

what is the baby blues

A

1-3 days post natal mood drop - due to hormonal changes

doesn’t need treatment

167
Q

where do uterine contractions start in labour

A

fundus of the uterus - move down and across

168
Q

how far must the cervix be dilated before assisted/ instrumental delivery is offered

A

10cm

169
Q

what drug is given to treat thromboembolic disease in pregnant women

A

LMW heparin

170
Q

how many sperm are produced each day

A

30 million

171
Q

where is progesterone released from

A

corpus luteum

172
Q

what mechanical changes occur during pregnancy

A

changed shape of spine

relaxin hormone relexis joints like the pubic symphis to give space

173
Q

what does the 3rd stage of labour last between

A

birth of baby > expulsion of placenta/ membranes

174
Q

when is emergency caesarean section essential

A

obstructed labour

fetal distress before cervix is fully dilated

175
Q

how many days past term would a mother get induced

A

7 days

risk of still birth

reproduction (6 decks)

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